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Montana rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Insurance Carrier
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $630.96 / $691.83
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $691.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $85.11